scholarly journals Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Lisandro Montorfano ◽  
Qian Yu ◽  
Stephen J. Bordes ◽  
Shankarapryan Sivanushanthan ◽  
Raul J. Rosenthal ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Mean Value ◽  
Cochrane Library ◽  
Clinical Settings ◽  
Increased Intracranial Pressure ◽  
The Mean ◽  
Increased Icp

Abstract Objectives Timely diagnosis and treatment of increased intracranial pressure can decrease morbidity and prevent mortality. The present meta-analysis aims to determine the mean value of the ONSD measured in patients with various elevated ICP etiologies under different clinical settings, as well as comparing the value of ONSD between patients with and without elevated ICP. Methods This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement8. PubMed, Embase, and Cochrane Library were searched to identify ONSD measured by US for patients with increased ICP from establishment to October 2020. Results A total of 779 patients with elevated ICP among 22 studies were included in the present meta-analysis. Studies were published between 2003 and 2020. Eighteen were comparative (18/22, 81.8%), and four were single-armed study (4/22, 18.2%). Twenty were prospective studies (20/22, 90.9%). There was moderate-to-high heterogeneity based on the prediction ellipse area and variance logit of sensitivity and specificity. Conclusions The mean value of the ONSD among patients diagnosed with increased ICP was 5.82 mm (95% CI 5.58–6.06 mm). Variations were observed based on etiology of intracranial hypertension, clinical settings where ONSD was measured, and standards for diagnosing intracranial hypertension. The US-ONSD among patient with elevated ICP was significantly higher than the normal control. Although a cut-off value is not clearly determined, these mean values can be implemented to evaluate the sensitivity and specificity of US-ONSD in diagnosing intracranial hypertension in future studies.

Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis

2017 ◽  
Vol 10 (3) ◽  
pp. 310-314 ◽  
Author(s):  
Tarek A Shazly ◽  
Ashutosh P Jadhav ◽  
Amin Aghaebrahim ◽  
Andrew F Ducruet ◽  
Brian T Jankowitz ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Medical Therapy ◽  
Venous Sinus ◽  
Increased Intracranial Pressure ◽  
Rnfl Thickness ◽  
Group A ◽  
Sinus Stenosis ◽  
The Mean ◽  
Group B

IntroductionMedical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP.Methods12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry. All subjects had papilledema and demonstrated radiological evidence of dural venous sinus stenosis.ResultsSix subjects chose venous stenting (Group A) and six declined and were managed conservatively with oral acetazolamide (Group B). The relative pressure gradient across the venous narrowing was 29±16.3 mm Hg in Group A and 17.6±9.3 mm Hg in Group B (p=0.09). The mean lumbar puncture opening pressure was 40.4±7.6 cm H2O in Group A and 35.6±10.6 cm H2O in Group B (p=0.4). Spectral domain optical coherence tomography (SD-OCT) showed mean average retinal nerve fiber layer (RNFL) thickness of 210±44.8 µm in Group A and 235±124.7 µm in Group B. However, the mean average RNFL thickness at 6 months was 85±9 µm in Group A and 95±24 µm in Group B (p=0.6). The total duration of acetazolamide treatment was 188±209 days in Group A compared with 571±544 days in Group B (p=0.07).ConclusionsIn subjects with venous sinuses stenosis, endovascular stenting offers an effective treatment option for intracranial hypertension which may shorten the duration of medical therapy.

Evaluation of the Relationship Between NIRS (Near-Infrared Spectroscopy) and Optic Nerve Sheath Diameter Measurement in Children with Increased Intracranial Pressure: A Pilot Study

2020 ◽  
Author(s):  
Didar Arslan ◽  
Dinçer Yildizdas ◽  
Özden ÖZGÜR HOROZ ◽  
Nagehan Aslan ◽  
Faruk İNCECİK
Keyword(s):  
Infrared Spectroscopy ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Near Infrared ◽  
Optic Nerve Sheath Diameter ◽  
Increased Intracranial Pressure ◽  
Mean Values ◽  
Nerve Sheath ◽  
The Mean ◽  
Increased Icp

Abstract Background: The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been increasing. In this study, our objective was to determine the significance of ONSD (Optic Nerve Sheath Diameter) and NIRS (Near-Infrared Spectroscopy) in children with increased ICP and any possible correlation between ONSD and NIRS. Methods: Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results: A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n=9; 25%) and non-traumatic bleeding (n=7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8±0.7 mm and 71.1±12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1±0.6 mm and 72.7±9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6±0.7 mm and 74.2±16% respectively. There was no correlation between the ONSD and NIRS values (r:0.3; p=0.07).Conclusion: Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

scholarly journals Effects of Midazolam on Cerebral Hemodynamics and Cerebral Vasomotor Responsiveness to Carbon Dioxide

1983 ◽  
Vol 3 (2) ◽  
pp. 246-249 ◽  
Author(s):  
A. Forster ◽  
O. Juge ◽  
D. Morel
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Cerebral Blood Volume ◽  
Water Soluble ◽  
Increased Intracranial Pressure ◽  
Beneficial Effects ◽  
The Mean

Although it is known that hypercarbia increases and benzodiazepines decrease cerebral blood flow (CBF), the effects of benzodiazepines on CBF responsiveness to CO2 are not well documented. The influence on CBF and CBF-C02 sensitivity of placebo or midazolam, which is a new water-soluble benzodiazepine, was measured in eight healthy volunteers using the noninvasive 133Xe inhalation method for CBF determination. Under normocarbia, midazolam decreased CBF from 40.6 ± 3.2 to 27.0 ± 5.0 ml 100 g−1 min−1 (x̄ ± SD). At a later session under hypercarbia, CBF was 58.8 ± 4.4 ml 100 g−1 min−1 after administration of placebo, and 49.1 ± 10.2 ml 100 g−1 min−1 after midazolam. The mean of the slopes correlating Paco2 and CBF was significantly steeper with midazolam (2.5 ± 1.2 ml 100 g−1 min−1 mm Hg−1) than with placebo (1.5 ± 0.4 ml 100 g−1 min−1 mm Hg−1). Our results suggest that midazolam may be a safe agent to use in patients with intracranial hypertension, since it decreases CBF and thus cerebral blood volume; however, it should be administered with caution in nonventilated patients with increased intracranial pressure, since its beneficial effects on cerebrovascular tone can be readily counteracted by the increase in arterial CO2 tension induced by this drug.

scholarly journals Evaluation of the relationship between NIRS (near-infrared spectroscopy) and optic nerve sheath diameter measurement in children with increased intracranial pressure: a pilot study

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Didar Arslan ◽  
Dinçer Yıldızdaş ◽  
Özden Özgür Horoz ◽  
Nagehan Aslan ◽  
Faruk İncecik
Keyword(s):  
Infrared Spectroscopy ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Near Infrared ◽  
Optic Nerve Sheath Diameter ◽  
Increased Intracranial Pressure ◽  
Mean Values ◽  
Nerve Sheath ◽  
The Mean ◽  
Increased Icp

Abstract Background The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been rising. In this study, our objective was to determine the significance and any possible correlation between Optic Nerve Sheath Diameter (ONSD) and Near Infrared Spectroscopy (NIRS) in children with increased ICP. Methods Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n = 9; 25%) and non-traumatic bleeding (n = 7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8 ± 0.7 mm and 71.1 ± 12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1 ± 0.6 mm and 72.7 ± 9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6 ± 0.7 mm and 74.2 ± 16% respectively. There was no correlation between the ONSD and NIRS values (r:0.307; p = 0.068). Conclusion Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

scholarly journals Resection of swollen temporal muscles in patients with intractable intracranial hypertension after decompressive craniectomy

2021 ◽  
Author(s):  
Shih-Hao Huang ◽  
Abel Po-Hao Huang ◽  
Sheng-Jean Huang ◽  
Lu-Ting Kuo
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Decompressive Craniectomy ◽  
Skull Fracture ◽  
Temporal Region ◽  
Brain Swelling ◽  
Increased Intracranial Pressure ◽  
Temporal Muscle ◽  
The Mean

Abstract Background Decompressive craniectomy is employed as treatment for traumatic brain swelling in selected patients. We discussed the effect of temporal muscle resection in patients with intractable intracranial hypertension and temporal muscle swelling after craniectomy. Methods Records of 280 craniectomies performed on 258 patients who were admitted with severe head injury were retrospectively reviewed. Eight patients developed intractable increased intracranial pressure with temporal muscle swelling within 24 h after craniectomy and were treated by muscle resection. Results The initial Glasgow Coma Scale score was 7 ± 1. The mean intracranial pressure was 41.7 ± 8.59 mmHg before muscle resection and 14.81 ± 8.07 mmHg immediately after surgery. Five patients had skull fracture and epidural hematoma at the craniectomy site. The mean intensive care unit stay was 11.25 ± 5.99 days. Glasgow Outcome Scale-Extended scoring performed during the 12-month follow-up visit showed that 6 patients (75%) had a favorable outcome. Conclusions Our study findings indicate that a direct impact on the temporal region during trauma may lead to subsequent temporal muscle swelling. Under certain circumstances, muscle resection can effectively control intracranial pressure.

Principles and Management of Increased Intracranial Pressure

2021 ◽  
pp. 466-472
Author(s):  
Shivram Kumar ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Brain Tissue ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Early Recognition ◽  
Increased Intracranial Pressure ◽  
Irreversible Damage ◽  
Brainstem Injury ◽  
Increased Icp

Intracranial pressure (ICP) is a reflection of the total volume inside the skull. Normal ICP is 5 to 15 mm Hg. Intracranial hypertension is defined as sustained ICP of more than 20 mm Hg. Increased ICP may lead to a reduction of cerebral perfusion pressure, a shift of brain tissue, and, as a result, secondary brainstem injury. Early recognition and treatment of elevated ICP are needed to prevent irreversible damage.

scholarly journals Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016194 ◽  
Author(s):  
Alex Koziarz ◽  
Niv Sne ◽  
Fraser Kegel ◽  
Waleed Alhazzani ◽  
Siddharth Nath ◽  
...  
Keyword(s):  
Systematic Review ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Optic Nerve Sheath Diameter ◽  
Increased Intracranial Pressure ◽  
Nerve Sheath ◽  
Registration Number ◽  
Increased Icp

IntroductionIncreased intracranial pressure (ICP) is a significant neurological issue that may lead to permanent neurological sequelae. When evaluating patients with traumatic brain injury, it is crucial to identify those with high ICP in order to expedite ICP lowering measures and maintain adequate cerebral perfusion. Several measures are used to recognise patients with increased ICP including CT scan, MRI, ICP monitor, and lumbar puncture (LP). However, these tests can be invasive, associated with radiation exposure, contraindicated, or not readily available. Ultrasonography measurement of the optic nerve sheath diameter (ONSD) is proposed as a non-invasive and quick measure to identify high ICP. The aim of this systematic review and meta-analysis will be to examine the accuracy of ONSD sonography for increased ICP diagnosis.Methods and analysesWe will include published and unpublished randomised controlled trials, observational studies, and abstracts, with no publication type or language restrictions. Search strategies will be designed to peruse the MEDLINE, Embase, Web of Science, WHO Clinical Trials, ClinicalTrials.gov, CINAHL, and the Cochrane Library databases. We will also implement strategies to search grey literature. Two reviewers will independently complete data abstraction and conduct quality assessment. Included studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We will construct the hierarchical summary receiver operating characteristic curve for included studies and pool sensitivity and specificity using the bivariate model. We also plan to conduct prespecified subgroup analyses to explore heterogeneity. The overall quality of evidence will be rated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).Ethics and disseminationResearch ethics board approval is not required for this study as it draws from published data and raises no concerns related to patient privacy. This review will provide a comprehensive assessment of the evidence on ONSD sonography diagnostic accuracy and is directed to a wide audience. Results from the review will be disseminated extensively through conferences and submitted to a peer-reviewed journal for publication.PROSPERO registration numberCRD42017055485.Clinical trial numberTrial registration number isNCT00783809.

scholarly journals Evaluation of cerebrovascular hemodynamics in patients with idiopathic intracranial hypertension using transcranial Doppler

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Mahmoud M. Allam ◽  
Hatem A. Almasry ◽  
Sandra M. Ahmed ◽  
Youssuf G. Taha ◽  
Mohammed I. Oraby
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Transcranial Doppler ◽  
Idiopathic Intracranial Hypertension ◽  
Pulsatility Index ◽  
Research Work ◽  
Increased Intracranial Pressure ◽  
Significant Relation ◽  
Before And After

Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure without a clear cause and can have serious visual effects. Previous research work suggests that transcranial Doppler measurements of pulsatility index correlate accurately with elevated intracranial pressure. Objective To assess the cerebrovascular hemodynamic changes in patients with IIH using transcranial Doppler before and after lumbar puncture and CSF withdrawal. Methods An interventional study conducted on 40 patients (31 females and 9 males) fulfilling the modified Dandy criteria for diagnosis of idiopathic intracranial hypertension, MRI brain, and MRV was done to the patients. Lumbar puncture was done for all included patients to measure intracranial pressure and CSF withdrawal. Transcranial Doppler was performed for all included before and after lumbar puncture and CSF withdrawal and the following parameters were measured: peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI). Results Significant relation was found between grades of papilledema and PSV, RI, and PI (p value 0.012, 0.025, 0.016) but no significant relation was found between grades of papilledema and EDV (0.102). Significant changes occurred in parameters of TCD pre- and post-CSF withdrawal including PSV, EDV, and PI (p value 0.001, 0.015, 0.019) denoting a significant change in cerebral hemodynamics after CSF withdrawal which denotes a decrease in intracranial pressure. Conclusion Increased intracranial pressure significantly affects cerebral blood flow. A normalization of transcranial Doppler parameters occurs following lowering of intracranial pressure through lumbar puncture and CSF withdrawal.

Multiple Suture Synostosis and Increased Intracranial Pressure following Repair of Single Suture, Nonsyndromal Craniosynostosis

1998 ◽  
Vol 35 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Roger J. Hudgins ◽  
Steven R. Cohen ◽  
Fernando D. Burstein ◽  
William R. Boydston
Keyword(s):  
Intracranial Pressure ◽  
Head Circumference ◽  
Cranial Sutures ◽  
Increased Intracranial Pressure ◽  
Common Multiple ◽  
Expansion Procedure ◽  
Delayed Closure ◽  
Single Suture ◽  
Less Common Multiple ◽  
Increased Icp

Objective Increased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36% of cases following correction of syndromal craniosynostosis. Although much less common, multiple suture closure may occur following repair of single suture, non-syndromal craniosynostosis and we present cases that concern two such children. Results Two children with nonsyndromal craniosynostosis, one metopic and one left-coronal, underwent fronto-orbital advancement at age 3 months. At age 19 months and at age 5 years, respectively, both patients re-presented with headaches, decrease in head circumference percentile, and acceptable cosmetic outcome. Both had computerized tomographic evidence of multiple closed cranial sutures and increased intracranial pressure (ICP) (determined by monitoring). Both patients improved following a cranial expansion procedure. Conclusion Delayed closure of multiple sutures and resultant increased ICP may occur following correction of nonsyndromal, single suture craniosynos-tosis. This may be more likely when the initial suture is contiguous with the facial sutures. Children should be followed for many years following cranio-synostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measurements to detect delayed closure of cranial sutures.

Sign in / Sign up

Export Citation Format

Share Document